Recovering from Tendinosis, aka “Climber’s Elbow”
I am trying to climb 5.12 by the time I turn 40 in November 2021. Stats say that most climbers working to reach this grade experience injury, so I have successfully made myself a statistic. Rehab has consumed the first couple months of this journey because I ended up with tendinosis, aka “climber’s elbow,” after the fall 2020 climbing season.
What is climber’s elbow and how do you know you have it?
Climbers elbow, or tendinosis, is microtears in the tendons that connect the muscles of your forearm to the bone. Tendons receive less blood than muscles do, so they strengthen and heal slower. Frequent hard climbing does not allow these microtears time to heal and they accumulate overtime, like a pile old climbing shoes we all have or have had. Congrats if you already cut ties with that pile of old, dirty, stinky rubber!
I knew I had tendinosis when simple tasks like reaching for dish soap caused a burning and stretching feeling at the impacted area of my forearm. I never felt discomfort climbing. The elbow injury section of Training for Climbing helped me diagnose myself, and my PT confirmed.
What is safe when recovering from injury?
When you are stuck with climber’s elbow, what can you do to keep training for climbing? With the proper instruction of a PT, (here is my PT) actually, kind of a lot. Breathe a sign of release and shift the focus of your training:
- heavy resistance training
- run
- hang-board hangs and modified hang-board pulls
- train pull-ups
- specific rehab exercises
Through rehab, I have done everything but climb hard.
Make a recovery plan and commit
Rehab is a commitment. Don’t commit, and you will end up like Kristie Alley, sometimes in skinny jeans and sometimes in sweatpants, back and forth on the same section of road on your circular journey to optimum health, and never making lasting forward progress.
However, if you want to have tendinosis every once and a while for the rest of your climbing life, (imagine the voice of the Punisher here) you do what you gotta do.
Make a plan when you commit to going through proper rehab. What works for me won’t necessarily work your you. Injuries are different and climbers are different. You have to talk to a PT. Here is the PT who helped me: Climb on Physical Therapy.
After talking to your PT, you can make a plan. Do your rehab exercises. And when you have been pain free for a while, get back into climbing slowly.
Rehab for Climber’s Elbow: Weeks 1-9
Is it slightly boring to go the gym and climb 5.6, 7, 8, 9 for 2 hours? Yes. But put on your blinders, don’t even look at the cool new lead on your favorite wall, because it will be down by the time you can climb it anyway. As Dom says in BroScienceLife, your muscle children will be fine, you are here for your tendon children.
In the 6th week of my recovery, you can see below, I learned the hard way that you need a gentle return to climbing. You can’t just pretend your tendons are fine and climb at max effort. Think about what your tendons are going through.
Here is exactly how I have progressed back into climbing:
- Week 1-5: No climbing. Gym closed anyway. Doing rehab exercises and other training. 2 weeks tendon pain free.
- Week 6 Session #1: Auto-belayed 4 easy vertical routes, 2 10+, one 11-, and one 11+. This was way too much. Took 3 days to be pain free again.
- Week 6 Session #2: Auto-belayed climbing up and down, 4 5.8-9 routes. GOOD!
- Week 7 Session #1: Lead 4 vertical to slightly overhanging 5.9 routes. GOOD!
- Week 7 Session #2: TR 8 vertical to slightly overhanging routes. 5 5.9 and 3 10-. GOOD!
- Week 8 Session #1: TR 8 vertical to slightly overhanging routes. 4 5.9, 3 10-, 1 10. GOOD!
- Week 8 Session #2: TR 8 vertical to slightly overhanging routes. 3 5.9, 4 10-, 1 10+ GOOD!
- Week 9 Session #1: TR/Lead 8 vertical to slightly overhanging routes. 3 5.9, 4 10-/+, 1 11- GOOD!
- Week 9 Session #2: TR/Lead 8 vertical to slightly overhanging routes. 3 5.9, 4 10/11-, 1 11 GOOD!
You can see how slowly I am progressing, but I am staying 98% pain free. The walls at my gym are 50-55 feet tall, so each session represents 400-450 feet of climbing. Also, after each climbing day, I do my rehab exercises and other weight training stuff in what I like to call my après climbing workout. Bench press and shoulder press and whatnot.
Weeks 10-13: Hopefully getting back to 100%
I am starting my 10th week of recovery/rehab from some tendinosis in my right forearm. Here is my plan breakdown:
- Week 10 Session #1 TR/Lead 8 vertical to slightly overhanging routes 2 5.9, 5 10/11, 1 11+
- Week 10 Session #2: TR/Lead 8 vertical to slightly overhanging routes 2 5.9, 5 10/11+, 1 12-
- Week 11 Session #1: TR/Lead 8 vertical to slightly overhanging routes 2 5.9, 5 10/11+, 1 12
- Week 11 Session #2: TR/Lead 8 vertical and overhanging 5.10 routes
- Week 12 Session #1: TR/Lead 8 vertical and overhanging 5.10-11- routes
- Week 12 Session #2: TR/Lead 8 vertical and overhanging 5.10-11 routes
- Week 13 Session #1: TR/Lead 8 vertical and overhanging 5.10-11+ routes
- Week 13 Session #2: TR/Lead 8 vertical and overhanging 5.10-12 routes
If at any point a climbing session makes my tendinosis flare up, I will simply take a step back, repeat the previous session, and again attempt the trouble session. This would allow my tendon one extra week to heal up.
What rehab/prehab do you do outside the gym for climber’s elbow?
This is where you pay your PT to help you out. We are different climbers, what works for me won’t automatically work for you. If you want to approach your rehab with confidence, then you need the expertise of a PT to build a plan for you. Before I even put my harness on, I have done 3 exercises to train and warm up. Here is the non-climbing part of my rehab plan:
- 3 specific eccentric forearm movement exercises 2x a week
- IYT climbing warm up exercises with a stretchy band
- IYT strength exercises on TRX 2x a week
- hang-board hangs and pulls 2x a week
Bonus Lesson: Climb Statically
I recently asked some advice of one of my favorite groups on Facebook, Climber’s Crag. Yes, I got a whole litany of opinions, because it is Facebook, but the responses reframed my thinking and lead me to learn more. The group encouraged me to think less about the grade and steepness of the climb and more about how fast I was loading my tendons.
I might try a vertical 11+ that I can climb statically but has tough pinches that I have to squeeze hard or a couple small crimps. Or, I might try an overhanging 11 that has a section of dead-point moves. Which route should I do? The more difficult vertical static climb or the less difficult over hanging climb with dead-point moves? Answer: the static one.
Moving into harder climbs, it is important to keep the climbing static and the load on the tendons slow and controlled.
Here is another climbing blog post that explains the importance of loading tendons in a controlled way and not quickly, like you would in a dead-point move.
Injury can be good for you
Injury can force is to be meticulous about our training for climbing. I want my tendon to be strong, and to achieve that I can’t just prop my arm up on a fluffy pillow for 3 months. If I did that, then it would heal and end up weaker instead of stronger. Here is a list of tangible benefits I have experienced from 10 weeks of consistent rehab:
- I can do 3 sets of 7 pull ups now, before I was doing 3 sets of 3.
- I can almost do my full hang-board routine on a 20mm rung.
- Increased weight on all major lifts
- More knowledge about prehab exercises to prevent future injury.
- My climbing warm up routine is designed to train weaknesses and prevent injury.
- I can TR a 55 foot slightly overhanging 11 and be pain free the next day.
Aside from TR the 11, I couldn’t do any of that 9 weeks ago. I am optimistic that I will actually be stronger after all of this.
The best way to get better at climbing is to improve weaknesses, and that is exactly what rehabbing an injury forces. Rehab forces us to listen to what our bodies need and to accommodate our training to meet that need. Nothing bad about that.